Bizarre tumor case may lead to more customized cancer care

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It's a medical nightmare: A 24-year-old man endures 350 surgeries since childhood to remove growths that keep coming back in his throat and have spread to his lungs, threatening his life. Now doctors have found a way to help him by way of a scientific coup that holds promise for millions of cancer patients.

The bizarre case is the first use in a patient of a new finding: how to keep ordinary and cancerous cells alive indefinitely in the lab.

The discovery allows doctors to grow “mini tumors” from each patient's cancer in a lab dish, then test various drugs or combinations on them to see which works best. It takes only a few cells from a biopsy and less than two weeks to do, with materials and methods common in most hospitals.

Although the approach needs much more testing against many different types of cancer, researchers think it could offer a cheap, simple way to personalize treatment without having to analyze each patient's genes.

“We see a lot of potential for it,” said one study leader, Dr. Richard Schlegel, pathology chief at Georgetown Lombardi Comprehensive Cancer Center in Washington. “Almost everyone could do it easily.”

An independent expert agreed.

For infections, it's routine to grow bacteria from a patient in lab dishes to see which antibiotics work best, Dr. George Q. Daley of Children's Hospital Boston and the Harvard Stem Cell Institute said in an email. “But this has never been possible with cancer cells because they don't easily grow in culture,” he said.

The new technique may reveal in advance whether a person would be helped by a specific chemotherapy, without risking side effects and lost time if the drug doesn't work. “Pretty nifty,” Daley wrote.

In the case of the 24-year-old, described in today's New England Journal of Medicine, lab-dish tests suggested that a drug used to treat a type of blood cancer and some other unrelated conditions might help.

It's not a drug that doctors would have thought to try, because the man technically does not have cancer. But his lung tumor shrank after a few months of treatment, and he has been stable for more than a year.

Two years ago, the growths to his lungs became extensive and life-threatening, and his physician, Dr. Scott Myers, described the condition at a meeting of Georgetown hospital specialists. “It's crushing the airway,” Myers said.

Doctors suggested that the new lab method pioneered by Schlegel and others might help. It borrows an idea from stem cell researchers: adding mouse cells for nourishment, plus a chemical that prevents cell death to an ordinary lab culture medium. That enabled healthy and cancerous cells to keep growing indefinitely.

Researchers grew “mini tumors” from the man's lung mass and from healthy tissue and screened various drugs against them. One proved ineffective. Another worked against the tumor but at too high a dose to be safe. The third did the trick.

A similar approach could let doctors screen drugs for cancer patients.

“What could be more personalized than taking this person's cell, growing it in culture, finding a drug to treat them and then treat them?” said Doug Melton, co-director of the Harvard Stem Cell Institute. The Georgetown method gives an answer quickly enough that it could save lives, he said.

The National Institutes of Health paid for much of this work and has already sent research teams to Georgetown to learn the method. About a dozen other universities have done the same, Schlegel said.

So far, his lab has grown prostate, breast, lung and colon cancer cells. Georgetown University is seeking a patent on the method.

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